Would you give birth in a midwifery led unit?

[JuJu300]

The reason that the United States has one of the highest rates for neo-natal death is that the standards are set so high compared to other countries. Any baby born after 23 weeks or taking spontaneous respirations is consider a live birth in the United States. In places like Austria a live birth is after 28 weeks of gestation. We are very advance in fertility treatment that leads to a lot of multiple births. Mid-wives do not take on these high risk cases. The doctors in the hospital end up having to delivery babies with no prenatal care, high risk, multiple births, premature 23-24 weeks, and mother's on drugs during their pregnancies. Of course, there is going to be a higher rate of death and complications. I'm sure doctors would love the break of getting delivery all full term healthy babies. If you have a baby at home full term with no complications during your pregnancy you probably will be fine, but you can't guarantee that. So, when you ask who needs doctors you can't be serious. Do you have any family members that have given birth prematurely or with complications at home? You can go to Wikipedia on line and research all of this. All the statics and facts are right there. I suppose people don't understand this until they see a 24 week old baby on high frequency oscillator fighting for their life in the NICU.

[Novella]

I had planned on having my daughter in a midwife led unit however I was only 36 weeks when I went into labour however the birth was managed by my midwife with a neonatologist there to review my daughter after the birt.

For low risk pregnancys I beleive midwife led care during pregnncy, birth and postnatally should be an available option. I am going through the birth centre again this time. I want as minimal intervention as possible.

I feel that obstertricians have an important role in pregnancies with medical complications.

juju300 - if you are discussing statistics/studies many studies have been done that show low risk pregnancies and home birth is equally as safe if not safer than hospital birth for low risk pregnacies. Maternal and neonatal death rates are the same or higher for low risk pregancies in hospital compared to homebirths attended by qualafied midwives. I beleive that there is a place for obstertricians and that is in the hospital attending women who have medical complications of pregnancy.

I hope kelly doesn't mind but here is a link of one such article
Outcomes of planned home births with certified professional midwives: large prospective study in North America -- Johnson and Daviss 330 (7505): 1416 -- BMJ
there are many more if you choose to google the topic.

I think women should have the right to choose where they birth by being given accurate information.

I am a nurse and I think there are times when I see the worst outcomes of an illness and it skews my preception as I don't see the x number of people with really good outcomes as they don't need my assistance.

[JuJu300]

While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that "First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country." [2] However, all of the countries named adopted the WHO definition in the late 1980s or early 1990s.[2]

Historically, until the 1990s Russia and other countries of the former Soviet Union did not count as a live birth or as an infant death extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least 7 days.[3] Although such extremely premature infants typically accounted for only about 0.005 of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%-25% lower reported IMR.[4] In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.[5]

Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries and suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.[6]

Another seemingly paradoxical finding is that when countries with poor medical services introduce new medical centers and services, instead of declining the reported IMRs often increase for a time. The main cause of this is that improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area and not been reported to the government might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase.

[edit] Global infant mortality trends

[JuJu300]

While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that "First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country." [2] However, all of the countries named adopted the WHO definition in the late 1980s or early 1990s.[2]

Historically, until the 1990s Russia and other countries of the former Soviet Union did not count as a live birth or as an infant death extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least 7 days.[3] Although such extremely premature infants typically accounted for only about 0.005 of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%-25% lower reported IMR.[4] In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.[5]

Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries and suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.[6]

Another seemingly paradoxical finding is that when countries with poor medical services introduce new medical centers and services, instead of declining the reported IMRs often increase for a time. The main cause of this is that improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area and not been reported to the government might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase.

[JuJu300]

Libertarian Party | Smaller Government | Lower Taxes | More Freedom

That is pretty funny that you gather me for a libertarian from my postings. I'm not sure if you know what a Libertarian is then. I'm assuming when you said we pay tax that you meant taxes. I think it would be great for everyone to be able to seek medical care where ever they like. Unfortunately, we are having a hard enough time covering the medical cost of sick children and adults in this country. We have a long ways to go to get to that point. I think it would be great if doctors and mid-wives worked together for the best optimal care of mother and baby. I still would choose to have my baby in the hospital. Some mid-wives will go to the hospital with you.

[La pachamama]

Libertarian Party | Smaller Government | Lower Taxes | More Freedom

That is pretty funny that you gather me for a libertarian from my postings. I'm not sure if you know what a Libertarian is then. I'm assuming when you said we pay tax that you meant taxes. I think it would be great for everyone to be able to seek medical care where ever they like. Unfortunately, we are having a hard enough time covering the medical cost of sick children and adults in this country. We have a long ways to go to get to that point. I think it would be great if doctors and mid-wives worked together for the best optimal care of mother and baby. I still would choose to have my baby in the hospital. Some mid-wives will go to the hospital with you.

JuJu my post was directed to kuraiza, I wrote her name at the beginning of my post to indicate this. I was not responding to your post.

[Mum2seven]

Hi Kelly

Yes Please make me Mum2seven!!!

I think we will call our little one Quinn.

JuJu I understand your concerns as a NICU Nurse, but I find it insulting that you use the weight of this fear to dissuade against midwifery care and homebirth.

Your assertions re oxygen deprivation and injury are extreme. You have also not honoured the wealth of evidence not only demonstrating the safety of midwifery care and homebirth but also the risk of medicalised childbirth today.
Why do we have such full NICU's? Let's look at all the iatrogenic (as a result of healthcare) injury. Around 70% of babies born by c/s spend time in special care/NICU.

It is irrelevant and unfair to compare seriously ill/premmie babies to a mode of birth (when the vast majority of incidences are unrelated).

Please look at the study of all planned homebirths in the U.S (Johnson and Daviss BMJ) This study looked at all planned homebirths and found stunning results (A 3% c/s rate for example). The other US study is MacDorman and this examined 5 million births where vaginal birth and c/s were compared when there was NO MEDICAL COMPLICATION and found nearly 3 times more babies died from c/s birth than vaginal (remember they were healthy to start with!)

Background: The percentage of United States? births delivered by cesarean section
has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality risks associated with primary cesarean section compared with vaginal delivery for singleton full-term (37?41 weeks? gestation) women with no indicated medical risks or complications.

Methods: National linked birth and infant death data for the 1998?2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors.

Results: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death.

Conclusions: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. (BIRTH 33:3 September 2006)

Justine Caines